The University of Cincinnati (UC) Hub and Spoke System combines the strengths of three regional academic health centers (AHC) and several community hospitals to provide a robust and readily accessible infrastructure for rapid implementation and high quality performance of clinical trials in a breadth of emergency indications. Our institution and our partners have a strong history of outstanding acute clinical trial performance spanning the prehospital, emergency department (ED), hospital floor and intensive care unit (ICU) environments. Our Hub and Spoke System has a proven history of effective clinical trial enrollments combined with efficient protocol adherent practices. UC will serve as the administrative Hub for our network. Our AHC spokes at University of Kentucky and University of Louisville will expand our catchment of acutely ill and injured patients, and the SIREN Network will benefit from their existing research infrastructures. The unique patient populations of the AHC spokes will be complemented by our community hospital spokes; our partnership with these community hospitals has an established track record of success in Cincinnati. Furthermore, the SIREN objectives uniquely align with UC?s institutional and Clinical and Translational Science Award (CTSA) objectives, especially our Acute Care Research Council; this Council aims to build a coordinated acute care research program that covers the entire region. Expertise of our leadership team include prehospital care, emergency cardiac care, emergency neurological care, and trauma/critical care. Our overarching goal is to bring more than just participants to the SIREN Network; we will meaningfully contribute to the growth and success of SIREN through communication and collaboration with other systems to maximize the effectiveness of the entire network.